BMC medical imaging · 2026
A novel face-level blast mechanism: CT findings of neuro-ocular injury from a mass-casualty event.
СтатьяНазвание и аннотация: Перевод в очереди
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Tamer Christel, Ltaif Diana Abou, Ghalayini Taima, El Sardouk Omar, Rizkallah Joe, Zeid Farah Abou, El Harake Aya, Cherri Hassan, Ghanem Alain Abi, Hourani Roula
Аннотация
BACKGROUND: On September 17, 2024, thousands of handheld communication devices detonated simultaneously across Lebanon, producing a mass-casualty event with an unprecedented close-proximity blast mechanism. Because the devices were held at face level, victims sustained highly localized craniofacial and hands, and to a lesser extent, neck injuries. This article aims to characterize the spectrum, severity, and distribution of intracranial, craniofacial, orbital, and neck injuries among victims presenting to a tertiary trauma center. To our knowledge, this study represents the first radiological characterization of neuro-ocular injury patterns resulting from synchronized handheld device detonations.
METHODS: This retrospective study included all patients presenting to the American University of Beirut Medical Center (AUBMC) within 24 hours of the event who underwent head, neck, and/or orbital imaging. Patients without blast-related injuries or without neuro-ocular imaging were excluded. Computed Tomography (CT) findings were recorded using standardized neuro-ocular trauma categories.
RESULTS: Of 177 patients presenting after the blast, 153 had blast-related injuries, and 103 underwent brain and orbit CT scan. Head injuries were highly prevalent (93.2%). Intracranial hemorrhage (ICH) occurred in 39.8%, most commonly hemorrhagic contusions (22.3%), and subarachnoid hemorrhage (SAH) (21.4%). Skull and facial fractures were present in 65%. Orbital injuries occurred in 82.5%, including orbital wall fractures (54.4%). Ocular trauma was severe, with globe rupture in 56.3% of patients (24.1% bilateral), penetrating globe injuries in 28.2%. Vitreous hemorrhage was the most common posterior segment injury (35.9%). Neck injuries occurred in 13.6% of patients, most commonly retained shrapnel and subcutaneous emphysema, with occasional extension into deep neck spaces and one case of laryngeal injury. Shrapnel was predominantly localized to the face (89.3%) and orbits (74.8%). Incidental intracranial findings were identified in approximately 1-2% of imaged patients.
CONCLUSIONS: The pager detonations produced an extraordinary concentration of craniofacial, orbital, and neck trauma, with rates of ICH, skull fractures, and globe rupture exceeding those reported in previous civilian mass-casualty events. The face-level, close-contact blast mechanism explains the intense neuro-ocular injury burden. Rapid CT imaging proved essential for identifying injury severity, guiding surgical intervention, and supporting coordinated ophthalmologic-neurosurgical management. These findings underscore the need for specialized preparedness in future unconventional blast scenarios.
METHODS: This retrospective study included all patients presenting to the American University of Beirut Medical Center (AUBMC) within 24 hours of the event who underwent head, neck, and/or orbital imaging. Patients without blast-related injuries or without neuro-ocular imaging were excluded. Computed Tomography (CT) findings were recorded using standardized neuro-ocular trauma categories.
RESULTS: Of 177 patients presenting after the blast, 153 had blast-related injuries, and 103 underwent brain and orbit CT scan. Head injuries were highly prevalent (93.2%). Intracranial hemorrhage (ICH) occurred in 39.8%, most commonly hemorrhagic contusions (22.3%), and subarachnoid hemorrhage (SAH) (21.4%). Skull and facial fractures were present in 65%. Orbital injuries occurred in 82.5%, including orbital wall fractures (54.4%). Ocular trauma was severe, with globe rupture in 56.3% of patients (24.1% bilateral), penetrating globe injuries in 28.2%. Vitreous hemorrhage was the most common posterior segment injury (35.9%). Neck injuries occurred in 13.6% of patients, most commonly retained shrapnel and subcutaneous emphysema, with occasional extension into deep neck spaces and one case of laryngeal injury. Shrapnel was predominantly localized to the face (89.3%) and orbits (74.8%). Incidental intracranial findings were identified in approximately 1-2% of imaged patients.
CONCLUSIONS: The pager detonations produced an extraordinary concentration of craniofacial, orbital, and neck trauma, with rates of ICH, skull fractures, and globe rupture exceeding those reported in previous civilian mass-casualty events. The face-level, close-contact blast mechanism explains the intense neuro-ocular injury burden. Rapid CT imaging proved essential for identifying injury severity, guiding surgical intervention, and supporting coordinated ophthalmologic-neurosurgical management. These findings underscore the need for specialized preparedness in future unconventional blast scenarios.